Western Illinois University Counselor Education Mid‐Semester Review Practicum Student Evaluation Student Information Name Practicum Site Date Supervisor Review Period Start Date End Date Total Hours Completed (Required) Professionalism Does NOT Meet Criteria Needs Improvement Meets Criteria Proper Attire, professional Arrives on time Completes assignments on time Communications skills – uses tact and diplomacy with other professionals, teachers, parents and students Ethical behavior – knowledge of an adherence to ACA Code of Ethics Additional Comments Page 1 of 6 N/A Helping Relationships Does NOT Meet Criteria Demonstrates an understanding of essential interviewing and counseling skills Needs Improvement Meets Criteria N/A Demonstrates knowledge of counseling theories that effectively conceptualizes client presentation and selects and implements appropriate counseling interventions Demonstrates knowledge of ethical and legal considerations in counseling relationships (i.e., confidentiality, transference, professional boundaries) Additional Comments Communication Skills and Abilities Demonstrates the ability to establish relationships in such a manner that working alliance can be created Understanding content – understanding the primary elements of the client’s story Does NOT Meet Criteria Needs Improvement Page 2 of 6 Meets Criteria N/A Understanding context – understanding the uniqueness of the story elements and their underlying meanings Responding to feelings – identifying affect and addressing those feelings in an therapeutic manner Congruence – genuineness; external behavior consistent with internal affect Establishing and communicating empathy – taking the perspective of the individual without over identifying, and communicating this experience to the individual Non‐verbal communication – demonstrates effective use of head, eyes, hands, feet, posture, voice, attire, etc. Immediacy – communicating by staying in the here and now Timing – responding at the optimal moment Intentionality – responding with a clear understanding of the therapist’s therapeutic intention Collaborates with an individual to establish clear therapeutic goals Facilitates movement toward the individual’s goals Page 3 of 6 Demonstrates the capacity to match appropriate interventions to the presenting problem in a consistent manner Creates a safe environment Demonstrates analysis and resolution of ethical dilemmas Additional Comments Professional Dispositions Demonstrates appropriate self‐control (such as anger control, impulse control) in interpersonal relationships with faculty, peers, and others Demonstrates honesty, fairness, and respect for others Demonstrates an awareness of his or her own belief systems, values, needs and limitations and the effect of these on his or her work Demonstrates the ability to receive, integrate and utilize feedback from peers, teachers, and supervisors Exhibits appropriate levels of self‐assurance, confidence, and trust in own ability Does NOT Meet Criteria Needs Improvement Page 4 of 6 Meets Criteria N/A Follows professionally recognized conflict resolution processes, seeking to informally address the issue first with the individual(s) with whom the conflict exists Additional Comments Strengths Please identify the strengths of the practicum student. Please provide as much detail as possible. Areas for Growth Please identify the weaknesses of the practicum student. Please provide as much detail as possible and suggestions for addressing the need for growth. Page 5 of 6 Recommendation for Internship Yes No Uncertain At this point, would you recommend this student for internship? Verification of Review By signing this form, you confirm that you have discussed this review in detail with your supervisor. Signing this form does not necessarily indicate that you agree with this evaluation. Practicum Student Signature Supervisor Signature Supervisor preferred telephone number Date Supervisor preferred e‐mail address Evaluation reviewed by Date Page 6 of 6